Addiction


Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces an immediate psychological reward, despite substantial harm and other negative consequences. Repetitive drug use can alter brain function in synapses similar to natural rewards like food or falling in love in ways that perpetuate craving and weakens self-control for people with pre-existing vulnerabilities. This phenomenon – drugs reshaping brain function – has led to an understanding of addiction as a brain disorder with a complex variety of psychosocial as well as neurobiological factors that are implicated in the development of addiction. While mice given cocaine showed the compulsive and involuntary nature of addiction, for humans this is more complex, related to behavior or personality traits.
Classic signs of addiction include compulsive engagement in rewarding stimuli, preoccupation with substances or behavior, and continued use despite negative consequences. Habits and patterns associated with addiction are typically characterized by immediate gratification, coupled with delayed deleterious effects.
Examples of substance addiction include alcoholism, cannabis addiction, amphetamine addiction, cocaine addiction, nicotine addiction, opioid addiction, and eating or food addiction. Behavioral addictions may include gambling addiction, shopping addiction, pornography addiction, internet addiction, video game addiction, and sexual addiction. The DSM-5 and ICD-10 only recognize gambling addictions as behavioral addictions, but the ICD-11 also recognizes gaming addictions.

Signs and symptoms

of drug addiction can vary depending on the type of addiction. Symptoms may include:
  • Continuation of drug use despite the knowledge of consequences
  • Disregarding financial status when it comes to drug purchases
  • Ensuring a stable supply of the drug
  • Needing more of the drug over time to achieve similar effects
  • Social and work life impacted due to drug use
  • Unsuccessful attempts to stop drug use
  • Urge to use drug regularly
Other signs and symptoms can be categorized across relevant dimensions:
Behavioral ChangesPhysical ChangesSocial Changes

  • Angry and irritable
  • Changes to eating or sleeping habits
  • Changes to personality and attitude
  • Decreased attendance and performance in workplace or school setting
  • Fearful, paranoid and anxious without probable cause
  • Frequently engaging in conflicts
  • Frequent or sudden changes in mood and temperament
  • Hiding or in denial of certain behaviors
  • Lack of motivation
  • Periodic hyperactivity
  • Using substances in inappropriate settings
  • Abnormal pupil size
  • Bloodshot eyes
  • Body odor
  • Impaired motor coordination
  • Periodic tremors
  • Poor physical appearance
  • Slurred speech
  • Sudden changes in weight
  • Changes in hobbies
  • Changes to financial status
  • Legal problems related to substance abuse
  • Sudden changes in friends and associates
  • Use of substance despite consequences to personal relationships

    • Substance use disorder

    The DSM-5 discourages using the term "drug addiction" because of its "uncertain definition and its potentially negative connotation" and prefers the term "substance use disorder" to describe the wide range of the disorder, from a mild form to a severe state of chronically relapsing, compulsive pattern of drug taking.
    SUD, belongs to the class of substance-related disorders, is a chronic and relapsing brain disorder that features drug seeking and drug abuse, despite their harmful effects. This form of addiction changes brain circuitry such that the brain's reward system is compromised, causing functional consequences for stress management and self-control. Damage to the functions of the organs involved can persist throughout a lifetime and cause death if untreated. Substances involved with drug addiction include alcohol, nicotine, marijuana, opioids, cocaine, amphetamines, and even foods with high fat and sugar content. Addictions can begin experimentally in social contexts and can arise from the use of prescribed medications or a variety of other measures.
    It has been shown to work in phenomenological, conditioning, cognitive models, and the cue reactivity model. However, no one model completely illustrates substance abuse.
    Risk factors for addiction include:
    The diagnostic criteria for food or eating addiction has not been categorized or defined in references such as the Diagnostic and Statistical Manual of Mental Disorders and is based on subjective experiences similar to substance use disorders. Food addiction may be found in those with eating disorders, though not all people with eating disorders have food addiction and not all of those with food addiction have a diagnosed eating disorder. Long-term frequent and excessive consumption of foods high in fat, salt, or sugar, such as chocolate, can produce an addiction similar to drugs since they trigger the brain's reward system, such that the individual may desire the same foods to an increasing degree over time. The signals sent when consuming highly palatable foods have the ability to counteract the body's signals for fullness and persistent cravings will result. Those who show signs of food addiction may develop food tolerances, in which they eat more, despite the food becoming less satisfactory.
    Chocolate's sweet flavor and pharmacological ingredients are known to create a strong craving or feel 'addictive' by the consumer. A person who has a strong liking for chocolate may refer to themselves as a chocoholic.
    Risk factors for developing food addiction include excessive overeating and impulsivity.
    The Yale Food Addiction Scale, version 2.0, is the current standard measure for assessing whether an individual exhibits signs and symptoms of food addiction. It was developed in 2009 at Yale University on the hypothesis that foods high in fat, sugar, and salt have addictive-like effects which contribute to problematic eating habits. The YFAS is designed to address 11 substance-related and addictive disorders using a 25-item self-report questionnaire, based on the diagnostic criteria for SRADs as per the DSM-5. A potential food addiction diagnosis is predicted by the presence of at least two out of 11 SRADs and a significant impairment to daily activities.
    The Barratt Impulsiveness Scale, specifically the BIS-11 scale, and the UPPS-P Impulsive Behavior subscales of Negative Urgency and Lack of Perseverance have been shown to have relation to food addiction.

    Behavioral addiction

    The term behavioral addiction refers to a compulsion to engage in a natural reward – which is a behavior that is inherently rewarding – despite adverse consequences. Preclinical evidence has demonstrated that marked increases in the expression of ΔFosB through repetitive and excessive exposure to a natural reward induces the same behavioral effects and neuroplasticity as occurs in a drug addiction.
    Addiction can exist without psychotropic drugs, an idea that was popularized by psychologist Stanton Peele. These are termed behavioral addictions. Such addictions may be passive or active, but they commonly contain reinforcing features, which are found in most addictions. Sexual behavior, eating, gambling, playing video games, and shopping are all associated with compulsive behaviors in humans and have been shown to activate the mesolimbic pathway and other parts of the reward system. Based on this evidence, sexual addiction, gambling addiction, video game addiction, and shopping addiction are classified accordingly.

    Causes

    Personality theories

    are psychological models that associate personality traits or modes of thinking with an individual's proclivity for developing an addiction. Data analysis demonstrates that psychological profiles of drug users and non-users have significant differences and the psychological predisposition to using different drugs may be different. Models of addiction risk that have been proposed in psychology literature include: an affect dysregulation model of positive and negative psychological affects, the reinforcement sensitivity theory of impulsiveness and behavioral inhibition, and an impulsivity model of reward sensitization and impulsiveness.

    Neuropsychology

    The transtheoretical model of change can point to how someone may be conceptualizing their addiction and the thoughts around it, including not being aware of their addiction.
    Cognitive control and stimulus control, which is associated with operant and classical conditioning, represent opposite processes that compete over the control of an individual's elicited behaviors. Cognitive control, and particularly inhibitory control over behavior, is impaired in both addiction and attention deficit hyperactivity disorder. Stimulus-driven behavioral responses that are associated with a particular rewarding stimulus tend to dominate one's behavior in an addiction.

    Stimulus control of behavior

    In operant conditioning, behavior is influenced by outside stimulus, such as a drug. The operant conditioning theory of learning is useful in understanding why the mood-altering or stimulating consequences of drug use can reinforce continued use and why the addicted person seeks to avoid withdrawal through continued use. Stimulus control is using the absence of the stimulus or presence of a reward to influence the resulting behavior.